State should protect Medicaid for people in need

Washington state officials sound prepared and optimistic about the Medicaid wind-down that can happen now that a continuous-coverage requirement from the federal government has been lifted off Medicaid.

The requirement was put in place during COVID-19 times and thought to be temporary. As the public health emergency went on and on, however, federal and state governments remained on the hook for providing Medicaid coverage to people who, in many cases, were no longer eligible for the taxpayer-provided safety net.

Think about people you know who lost a job when the government and COVID-19 curtailed business activity. Many of those people are again employed and have access to employer-provided health care. Others have restored incomes that are high enough to rule out Medicaid eligibility. Some people have aged out of the system, and others have died.

The state does not know who those people are, as there has not been a renewal requirement to determine eligibility for years. That isn’t good. Any penny used for ineligible recipients depletes taxpayer money available for people in need, for which the Medicaid program is built.

Right now, state Medicaid, also known as Apple Health, is about 2.2 million people strong. That means that one in four Washingtonians are on Medicaid, explained Dr. Charissa Fontinos, the state’s Medicaid director, on Inside Olympia. That includes 300,000 to 500,000 clients added during the public health emergency. (I am confused why we don’t know if that number is 300,000 or 500,000. I hope to find out. That’s a wide spread.)

In normal times, people renew their eligibility for Medicaid yearly. But in COVID times, the federal government made the “smart decision” to pause the renewal requirement and prohibit states from disenrolling clients, said Ingrid Ulrey, CEO of the Washington Health Benefit Exchange.

Getting the numbers down as quickly as possible would save taxpayers money and preserve resources for the needy. That should be a priority for our state, but it doesn’t seem to be.

The state is using the full 12 months allowed for redetermination of Medicaid eligibility that the federal government allows. And instead of making sure only people who need the taxpayer-financed safety net are in it, I hear state leaders expressing the desire to keep everyone who is on Medicaid enrolled.

During that episode of Inside Olympia, Fotinas and Ulrey both expressed gratitude for the state’s generosity with Medicaid. They said some other states are not employing the same 12-month wind-down process, suggesting those states don’t care about people’s health care. I heard similar gratitude at a meeting in which the state’s Health Care Authority was advising hospitals on how to help patients with Medicaid redetermination.

I would argue that cleaning up bloated Medicaid rolls as fast as possible is the smart, most compassionate thing to do for taxpayers and people in need. Aside from state cost-savings that could be realized, Medicaid is not known for patient-centered health care decisions or for paying its way. If people have the ability to obtain other, better coverage, they should. And having more people on Medicaid, including those who are not income eligible, hurts our entire health care system, making it more costly for people who pay for their coverage or receive it as a work benefit instead of wages.

If 12 months are needed to do redetermination work, then having 12 months is important. If the state is as ready for these redeterminations as it says, it should be determining client eligibility as aggressively and responsibly as it is conducting its outreach campaign to clients. Saving taxpayer dollars and preserving funds for people in need would make me grateful.

States have a strong incentive to figure out who is eligible and who is not in a timely manner. Enhanced federal COVID funding for Medicaid has already begun winding down and will be gone by the end of this year. And since most able-bodied, income-ineligible people enrolled in Medicaid have other sources of coverage available to them, there is no reason to be among the last of the states at the Medicaid-restoration table.